Provider Demographics
NPI:1104416858
Name:BRODY, TESS SARAH (CPM, LDEM)
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:SARAH
Last Name:BRODY
Suffix:
Gender:F
Credentials:CPM, LDEM
Other - Prefix:
Other - First Name:TOVA
Other - Middle Name:
Other - Last Name:BRODY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM, LDEM
Mailing Address - Street 1:3417 OLD COURT RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3122
Mailing Address - Country:US
Mailing Address - Phone:410-504-7798
Mailing Address - Fax:
Practice Address - Street 1:3417 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3122
Practice Address - Country:US
Practice Address - Phone:410-504-7798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDEM00029176B00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula